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Medical Education Section
Is this a picture of a basal cell skin cancer?
58 year old man has an odd bump on his face and diagnosed himself with a basal cell skin cancer after a complete "internet investigation" and is now seeking a "second opinion" from you.

What is your diagnosis?

Sebaceous hypeplasia.jpg Sebaceous hypeplasia.jpg
Sebaceous hyperplasia

Sebaceous hyperplasia is the most common of all pilosebaceous tumors. It is a disproportionate enlargement of the sebaceous glands found most commonly on the foreheads and cheeks of middle-aged to older individuals. These areas of hyperplasia consist of one or more lesions size 2 to 4 mm in diameter with umbilicated papules that most commonly have a yellowish hue. Pathologically, there is an increased number of mature sebocytes aggragated into large nodules that cluster around a central duct. This is commonly viewed as a central umbilication. The sebaceous lobules show proper maturation with only a single rim of basaloid cells at the periphery and the mature sebocytes within this central portion of the lobules. Sebaceous hyperplasia must be distinguished from basal cell carcinoma. Usually this can be determined clinically; however, in close cases, a biopsy may be warranted. Oftentimes the yellowish coloration and the central dell are key points in suggesting that it is indeed sebaceous hyperplasia.

Treatment: Often a biopsy will provide diagnostic material as well as remove the lesion. Destructive methods such as curettage, cryotherapy, mild electrodesiccation, carbon dioxide laser surgery, or topical application of medical grade acids can also be effective. A word of caution: In my clinical experience, one must be very, very careful at removing these lesions with shave biopsy to avoid making a scar worse than the original lesion. In patients with multiple sebaceous adenomas, one must rule out Muir-Torre syndrome.

Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology

Reference: Cutaneous Medicine and Surgery by Dover et al.

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